Trauma work in psychotherapy and keeping on keeping on

[erinaceus]

Does anyone have experience of psychodynamic psychotherapy for trauma?

I am finding psychotherapy difficult and am ambivalent about continuing. Specifically, the sessions are having a knock-on effect on my life outside of psychotherapy: my relationships, my work, anxiety levels, my eating, my sleep...I am going to speak to my treatment team about these effects but I am not sure that this difficult work can possibly be worth it.

I am not concerned about my safety (such as suicide or self-harm risk) nor about my ability to do my job - my employer are great, and my job is demanding but also somehow a soothing distraction. However, I am concerned about my relationships which seem to be suffering from collateral damage, and about my eating and sleeping which are really quite disrupted.

Does anyone have any advice on how to explain this to my therapist and psychiatrist, and/or practical strategies for the difficult times between the sessions? I am open to stopping going to psychotherapy or changing to a different therapeutic approach if either of those turns out to be the overall best thing to do, but wondered if anyone has any other suggestions I have not thought of yet.

Thanks MN.

Erinaceous sorry you're finding it so hard--can you tell us what the difficulty in particular is? Is it what your therapist says? Is it what you feel after the sessions? Psychotherapy can be very hard at times but really worth it IME if it's a good therapist.

Thanks stilllovingmysleep for replying.

I find it hard to express my feelings in the sessions. I see my therapist as judgemental and I dissociate in the sessions. Then I get hit by the emotions afterwards - some sort of therapy aftershock from everything that has been stirred up.

It can hit me if someone expresses strong emotions towards me at work, or even not that strong ones, and which I would typically be able to cope with. I am well aware that my colleagues are not a threat(!), but a difficult or confrontational meeting can leave me variously leaving work early, going for a cup of tea in the cafeteria and counting down the hours until the end of the working day, or sobbing in the disabled loo, none of which seem ideal.

Another problem is that my DH deals with the fallout and he is emotionally exhausted as well. My DH is not the cause of the trauma any more than my colleagues are(!) but my coming to terms with my past is taking its toll on my marriage and I worry that my marriage will end up being the victim of my past. DH has his own therapist for his own stuff and he and I have talked about going to couples' therapy in the future but right now neither of us has the emotional energy.

I feel like I need a better outlet, or a gentler therapist, or something, as I do not see the current situation as sustainable and nor does it look like it is going to be a quick fix. Hence questioning whether it is worth it at all. I feel like it is not worth sacrificing my marriage for. I am prone to catastrophising though - I do not think that my marriage is at a serious risk just yet nor that my DH would abandon me without talking to me first.This whole situation is just pretty miserable, and I was wondering whether there is a way to make it more bearable.

My friends are great, as is this board. I will talk to my therapist too. She has a direct style and I think she does not realise how much is being stirred up.

Yes, I have had (ongoing) psychodynami therapy for several years for C-PTSD. I can totally relate to what you're saying, and I have found RL hard at various points, BUT i think my therapist has been very good at getting a balance between uncovering unconscious processes and past emotions while also maintaining acceptable functioning and quality of life in the present.

When you say you experience your therapist as judgmental, do you mean you actually feel she is judging you, or that you experience the feeling while simultaneously being aware that it's not true in the present? It does sound as if she's not managing the dissociation well - is she aware that you're partially or wholly zoned out during the sessions? How does her 'direct style' manifest itself in her interactions with you?

Sorry, I'm now asking lots of direct questions as well! But I wonder how experienced she is at working with dissociation. It's a very complex and subtle process, and needs a therapist who is experienced and attuned to those, and also able to manage their own emotional reactions to having a client who dissociates. Many normal therapeutic techniques don't translate well to workign with dissociation, and this can be anxiety-provoking for therapists, which may in turn feed back into the therapy in all sorts of complex ways.

I think you do need to spell out to her what you've said here, and see if she can suggest a way forward that will improve things. Therapy is tough, but you shouldn't have to accept such an extreme reduction in your level of functioning over a long period - that's completely counter-productive.

Thank you 404. Your questions are helpful for me to think about and for me to bring up with my therapist.

this can be anxiety-provoking for therapists, which may in turn feed back into the therapy in all sorts of complex ways.

BTDT with previous therapist. Therapy, eh?

Update: I have a week off, and then I will start with a new therapist whom I think will be a better fit. My experience of MN as more validating than my now-ex-therapist was one of several indicators that it is in my best interest to change therapists.

Thank you both for your thoughtful replies

Update again:

Things are better with new therapist. However, the work is taking its toll on my marriage. At the moment I am absolutely committed to my husband, and I am not able to be the partner that he needs because I am working through such difficult stuff.

Has anybody been in a similar situation?

After so many people suggested it to me, I approached a couples' therapist for support. Scheduling a three way meeting is complicated - DH and I both lead full-on lives, yes, I know that this is part of the problem, and I am trying to get a handle on my work situation. The therapist started questioning my commitment to therapy, making statements about things we could work on which I do not see as a problem(!) and so on.

So: can couples' therapy just be a crutch for a relationship in a situation like this? Will a couples' therapist always try to fix the marriage, when we do not want to go looking for problems rooted in the marriage itself, and just need some strategies to get us through this?

It never occurred to me that working through all this could be such a big deal. I am safe and have a lot of support, but my poor husband whom I care about deeply has lost his wife and told me he is not sure he can take much more .

It's a really hard slog recovering from CPTSD. But it sounds like you're on course and making good progress. Well done!

TBH, any depth psychotherapy takes it toll on relationships. And it's clear your partner is reaching breaking point. He might perhaps benefit from individual therapy himself - a space where it's all about him and his needs. I wonder if you might find couples therapy too much - because you would be exposed to his raw pain. Could you handle that on top of all the stuff you're working through? Do you have the ability to contain it and deal with your feelings and frustrations about it?

But it's worth a try. I would advise interviewing a few couples therapists and explaining exactly what you need: practical support and encouragement to keep things patched up until you are able to fully rejoin the partnership. Shop around until you find a therapist who makes the right kind of noises!

Good luck.

Not sure if this is helpful, but I'm doing EMDR for cptsd and ptsd and see one psychologist for that. I do an integrated psychotherapy with another psychologist another day of the week to help deal with what comes up in (or out of) the EMDR and the more generalized cptsd stuff.

There is no way I could take on full couples therapy.

Perhaps, as a way of helping calm things for DH I might take on seeing a couples therapist once a month, as a check-in type of thing. Or as you mentioned your DH had a counsellor, see if he'd like you to go to some sessions with him (and if his therapist was wanting that). Those ideas would be to help find ways that can help your DH, with the understanding that you're not being asked to change, as that's too hard now, but to be aware of and supportive of his methods (old and new) of dealing with it all.

But with everything the sort of work you're doing entails, I definitely wouldn't undertake serious couples' work on a high frequency basis.

Thank you folks for your practical support. I had no plans for high intensity couples' stuff and was thinking about what I could do to help my DH whilst I am out of action. I feel confident we will emerge with our marriage intact, in part because what brought us together was a shared sense of humour so black that the first hours we spent alone together, chatting, before we were a couple, came to a close with me begging him to stop because the laughter was exhausting me.

The Brexit stuff is not helping with the surrealism. But hey. Thank you both for topping up my supplies of validation and pragmatism. My DH runs out from time to time.

Hi erinaceus, sorry to hear of your troubles.

I don't have any experience of psychodynamic therapy but I am currently having psychotherapy for very historical trauma and can relate to a lot of what you say.

I am very happy with my therapist and glad to hear you have found someone you are more comfortable with. I just wanted to say if you ever want to get in touch with someone who is going through something similar then please do PM me any time x

user1468841624 I hear you. I believe you. Thank you for posting. I appreciate it. It is good to know that I am not the only person going through this. It is hard. It is much better with my new therapist. I feel hopeful now. I can see how it might be worth it.

Keep going.

Update again: Did anyone experience a need to talk all the time. I feel as if I have self-policed for so long and I suddenly have a voice and am talking all the time. Not about the trauma, just in general. People who have known me for a long time reacted in various unhelpful ways, including expressing concern that I am developing hypomania. My psychiatrist screened me for hypomania or mania, and his comment was along the lines of, maybe [person] has only known you as depressed, maybe you have been depressed for the past X years.

It is as if I cannot get enough attention. I am hoping that I calm down in time. Objectively I am not so convinced that there is a terrible problem. It is more the change in me that is disruptive, and that I am hypersensitive to feedback about my taking up too much space. As if I am finding my voice, and other people who have expectations of how I will be are expecting a doormat and are not getting one. Something like that.

Related: My new therapist went on vacation for a few weeks. Bloody August.

Thank you everybody. This thread has been super-helpful for me.

Oh, some other people reacted in helpful ways, too. It is not all bad!